Percutaneous autologous bone marrow injection accelerates bone synthesis during bone transport using the Ilizarov system after recurrence: case report and literature review

Open tibial fractures with major bone loss, especially from high-energy trauma, are prone to atrophic nonunion, pseudoarthrosis, infection, and limb shortening. Standard methods like Ilizarov fixation often fail when healing is poor or infection persists, making adjunctive biological therapies necessary. Although the Ilizarov technique is established for tibial nonunion, evidence on mesenchymal stem cell (MSC)-rich bone marrow injections remains limited. We reported 2 young male patients with open tibial fractures and substantial bone loss. Both were initially managed with Ilizarov fixation for 7 - 8 months but subsequently developed atrophic nonunion, pseudoarthrosis, persistent infection with fistula, and limb shortening. Examination showed abnormal motion and absence of bone fragments, and labs confirmed ongoing infection. The definitive management involved a staged surgery, augmented by dual intraosseous injections of autologous MSC-rich bone marrow. This protocol successfully achieved bony union. The Ilizarov frame was then replaced with an AO fixator for consolidation. Both patients regained full limb length and infection resolution, with minor fibrotic tissue formation. Tibial pseudoarthrosis with infection and bone loss is challenging. In our cases, combining Ilizarov distraction with MSC-rich marrow enhanced osteogenesis, leading to union in a shorter time and full recovery. This synergy highlights the potential of regenerative strategies in complex orthopedic trauma.